A review of complications associated with craniocervical fusion surgery

Rishi Rajiv Lall, Nirav J. Patel, Daniel K. Resnick

Research output: Contribution to journalReview article

45 Citations (Scopus)

Abstract

Background: Fusion at the craniovertebral junction is performed to treat instability of the upper cervical spine and occiput. The literature consists exclusively of case series in which complication rate and avoidance are variably addressed. Objective: To describe the rates of various complications encountered during craniocervical fusions and discuss preoperative and perioperative strategies useful for risk reduction. Methods: A computerized search of PubMed for literature on craniocervical fusion and other upper cervical fusions was performed. Keywords used in the search included: occipitocervical fusion, odontoid screw, atlantoaxial fusion, with and without complications, anterior fixation, lateral mass screw, transarticular screw, halo, vertebral artery injury, and odontoid fracture. References were limited to studies on human subjects. Other sources were identified from the reference lists of relevant publications. Results: Twenty-two reports described data derived from 2274 procedures analyzed for complications. The most commonly encountered perioperative complications were related to instrumentation failure after nonunion with rates as high as 7% during occipitocervical fusion and 6.7% during atlantoaxial fusion. Other commonly encountered complications included injury to the vertebral artery (1.3%-4.1% during placement of C1-C2 transarticular screws, most commonly in the case of high-riding vertebral artery), dural tears, and wound infection. Conclusion: Occipitocervical or atlantoaxial fusion procedures can be performed with low morbidity. Safety is enhanced with appropriate preoperative assessment of anatomic variants and preparation for perioperative management of complications.

Original languageEnglish (US)
Pages (from-to)1396-1402
Number of pages7
JournalNeurosurgery
Volume67
Issue number5
DOIs
StatePublished - Nov 1 2010
Externally publishedYes

Fingerprint

Vertebral Artery
Wounds and Injuries
Wound Infection
Risk Reduction Behavior
Tears
PubMed
Publications
Spine
Morbidity
Safety
Atlanto-Axial Fusion

Keywords

  • C1-C2
  • Complication
  • Craniocervical
  • Fusion
  • Odontoid
  • Screw
  • Transarticular

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

A review of complications associated with craniocervical fusion surgery. / Lall, Rishi Rajiv; Patel, Nirav J.; Resnick, Daniel K.

In: Neurosurgery, Vol. 67, No. 5, 01.11.2010, p. 1396-1402.

Research output: Contribution to journalReview article

Lall, Rishi Rajiv ; Patel, Nirav J. ; Resnick, Daniel K. / A review of complications associated with craniocervical fusion surgery. In: Neurosurgery. 2010 ; Vol. 67, No. 5. pp. 1396-1402.
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AB - Background: Fusion at the craniovertebral junction is performed to treat instability of the upper cervical spine and occiput. The literature consists exclusively of case series in which complication rate and avoidance are variably addressed. Objective: To describe the rates of various complications encountered during craniocervical fusions and discuss preoperative and perioperative strategies useful for risk reduction. Methods: A computerized search of PubMed for literature on craniocervical fusion and other upper cervical fusions was performed. Keywords used in the search included: occipitocervical fusion, odontoid screw, atlantoaxial fusion, with and without complications, anterior fixation, lateral mass screw, transarticular screw, halo, vertebral artery injury, and odontoid fracture. References were limited to studies on human subjects. Other sources were identified from the reference lists of relevant publications. Results: Twenty-two reports described data derived from 2274 procedures analyzed for complications. The most commonly encountered perioperative complications were related to instrumentation failure after nonunion with rates as high as 7% during occipitocervical fusion and 6.7% during atlantoaxial fusion. Other commonly encountered complications included injury to the vertebral artery (1.3%-4.1% during placement of C1-C2 transarticular screws, most commonly in the case of high-riding vertebral artery), dural tears, and wound infection. Conclusion: Occipitocervical or atlantoaxial fusion procedures can be performed with low morbidity. Safety is enhanced with appropriate preoperative assessment of anatomic variants and preparation for perioperative management of complications.

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